EMPTY SELLA SYNDROME IV NUTRITION AND PHYSICAL ACTIVITY

Aquino, Felix SP
Sarmiento, Noel


IV. Nutrition and Physical Activity

According to Melmed (2008), there is no specific treatment if pituitary function is normal. Unless the disorder results in other medical problems, treatment is symptomatic and supportive. Thus, diet and physical activity that will be advised will depend also on the symptoms manifested by the patient with empty sella syndrome.

One of symptoms of ESS is intracranial hypertension. Intracranial hypertension is the general term for the neurological disorders in which cerebrospinal fluid pressure within the skull is too high.( Intracranial Hypertension Research Foundation, 2010). The main symptoms are headache, nausea and vomiting as well as pulsatile tinnitus, double vision and other visual symptoms.(Wikipedia, 2010)

There is little scientifically robust information regarding specific dietary measures for intracranial hypertension. Limiting vitamin A consumption and a low tyramine diet may be beneficial dietary sources rich in vitamin A include fish, eggs, carrots, sweet potatoes, leafy greens, broccoli, red bell peppers, tomatoes, apricots, and cantaloupe. Supplemental vitamin A preparations are available over-the-counter. Tyramine naturally accumulates in food during the aging process. Foods and beverage that have high tyramine content include aged cheese and meat, pickled foods, overripe or dried fruit, beer, and wine. As many of the high-tyramine foods are also migraine triggers, patients may be instructed to use resources that are available regarding diet.(Friedman and Jacobson, 2004)

The cause of visual field changes is due to either traction on the chiasm or involvement of chiasmal blood vessels, which result in ischemic damage to the optic nerve.(Choovuthayakorn, 2008)

Basically, a person with a visual field loss may have near normal visual acuity, the visual field loss may make walking in a crowd difficult because the ground cannot be seen. A visual field loss may also make reading difficult because the beginning or end of a sentence cannot be seen. Special glasses with prisms can be made to help a patient become more aware of their lost visual field, making navigation and reading easier. A low vision optometrist prescribes this type of eyeglasses.(Viewfinder, 2008)

Due to visual disturbances, patient is high risk for injury. Patient’s relative should be advise to assist patient in moving and attending self-care to promote safety of the patient.
Primary Empty Sella Syndrome results in CSF rhinorrhea in a very similar fashion as other spontaneous CSF leaks, but contains a congenital component.(Gleinser, 2009)

Conservative treatment has been advocated only in cases of immediate-onset CSF rhinorrhea following nonsurgical trauma. Conservative management consists of a 7-10 day trial of bed rest with the patient in a head-up position. A head-of-bed position at 15-30° is sufficient to reduce the CSF pressure at the basal cisterns. Coughing, sneezing, nose blowing, and heavy lifting should be avoided as much as possible. Stool softeners should be deployed to decrease the strain and increased ICP associated with bowel movements.(Welch, 2009)

Probably less than 10% of individuals with primary empty sella syndrome have some symptoms of hypopituitarism. Hypopituitarism can result in hypothyroidism, hypogonadism, and hypoadrenalism (Answer.com , 2010).

Hypothyroidism is decreased production of the thyroid gland, which can result in diminished metabolism, intolerance of cold temperatures, fatigue, mental and physical sluggishness, and constipation. Patients who manifest hypothyroidism in empty sella syndrome should follow this diet.

First and foremost patient need to up his water intake. Taking in more water will trick body into thinking that it doesn’t need to store water since it’s getting an abundant supply. Also, by drinking more water one able to flush the toxins out of your system that is causing the inflammation in bowels. (Hypothyroidism diet info, 2009).

In regards with flushing bowels patient will need to increase his fiber intake. By adding both soluble and insoluble fiber patient enable his body to retain more of the water that you drink to end up in the intestines where it will do the most good. There are plenty of natural sources of fiber but patient can always use a good dietary supplement. This tip has another benefit also. People with hypothyroidism suffer from constipation on a regular basis. This will help not only with the bloating but also with this often aggravating symptom of hypothyroidism. Last but not the least, salt intake should be lowered. Sodium’s effect on one’s body causes it to retain water. By reducing sodium intake not only are you doing your heart a favor you will also be able to flush water from you system more readily. (Hypothyroidism diet info, 2009).

Essentially patient must stay away from most foods that are what they call goitrogens. These are foods that interfere with the body’s absorption of iodine; and as a result suppress how your thyroid functions. These include raw broccoli, anything soy, peanuts, raw spinach and Brussels sprouts. (Hypothyroidism diet info, 2009).

The patient with hypothyroidism experiences decrease energy and moderate to severe lethargy. As a result the risk of complications from immobility increases. The patient’s ability to exercise and to participate in activities with further limited by changes in the cardiovascular and pulmonary status that occur secondary to hypothyroidism major role of the nurse is assisting in care and hygiene while encouraging the patient to participate in activities within established tolerance levels to prevent complications with immobility. (Bare et al, 2008)

Hypoadrenalism is the decreased production of the adrenal gland, which can result in low blood pressure and hypoglycemia. (Answer.com , 2010).Patients suffering from hypoadrenalism should eat an unrestricted diet. Patients with primary adrenal insufficiency should have ample access to salt because of the salt wasting that occurs if their condition is untreated. Infants with primary adrenal insufficiency often need 2-5 g of sodium chloride per day. The patient's caloric intake may need to be monitored. Restrict the patient's caloric intake if excess weight gain occurs and reevaluate the glucocorticoid dose because excess glucocorticoid administration stimulates appetite (Wilson, 2009)

No restrictions are necessary unless other manifestation will affect physical activity of patient. If patients exercise in warm climates, provide them with sufficient sodium chloride to prevent hyponatremia. Stress doses of glucocorticoids are generally not needed for exercise. (Wilson, 2009)

Hypogonadism refers to decreased production of sex hormones, which can result in loss of pubic hair, decreased sex drive, impotence in men, and amenorrhea (absence of menstrual cycle) in women. (Answer.com , 2010)

A way to increase sex hormones is by eating foods that are high in zinc. Some of these include oysters, bananas, artichokes, blackberries and avocados. In addition, increasing levels of arginine, one of the amino acids, can help increase sex drive and levels of blood to the genital area. Some foods that have arginine include Brazil nuts, almonds and pumpkin seeds (Livestrong.com, 2010)

In conclusion, different manifestation of empty sella syndrome will have different approach of treatment as well as diet and activity that will be advised to the patient. Helping patient to determine what diet and activity is appropriate for him/her alone is not sufficient. As a nurse we should emphasize a need for their adherence to advised activity. Through patient could help himself to improve his/her current health status.

Reference:

American Geriatric Society. (2005) Vision Loss and other Eye Diseases. Retrieved on February 18, 2010 at http://www.healthinaging.org/AGINGINTHEKNOW/chapters_ch_trial.asp?ch=26

Answer.com.(2010).Empty sella syndrome. Retrieved on February 16, 2010 at http://www.answers.com/topic/empty-sella-syndrome

Bare, B., Cheever, K., Hinkle, J., & Smeltzer, S. (2008).Textbook of Medical-Surgical Nursing.11th Edition p.1454.Lippincott Williams and Wilkins

Choovuthayakorn, J.(2008) Case Reports : Visual Field Defect in Primary
Empty Sella Syndrome. Retrieved on February 18, 2010 at http://www.rcopt.org/2009/download/05-10.pdf

Friedman, D. and Jacobson, D. (2004) Idiopathic Intracranial Hypertension. J Neuro-Ophthalmol, Vol. 24, No. 2. Retrieved on February 18, 2010 at http://pediatrics.uchicago.edu/chiefs/inpatient/documents/iihtn.pdf

Gleinser, D. (2009). CSF Rhinorrea. Retrieved on February 18, 2010 at http://www.utmb.edu/otoref/Grnds/CSF-leak-091120/CSF-leak-091120.pdf

Hypothyroidism diet info. (2009).Hypothyroidism Diet Tips. Retrieved on February 18, 2010 at http://www.hypothyroidismdietinfo.com/hypothyroidism-diet/hypothyroidsim-diet-tips-battle-of-the-bloat.php#more-204

Hypothyroidism diet info. (2009).What is a Hypothyroidism Diet? .Retrieved on February 18, 2010 athttp://www.hypothyroidismdietinfo.com/hypothyroidism-diet/what-is-a-hypothyroidism-diet.php

Intracranial Hypertension Research Foundation .(2010) Intracanial Hypertension. Retrieved on February 18, 2010 at http://www.ihrfoundation.org/

Livestrong.com.(2010) How to Increase a Man's Sex Drive. Retrieved on February 16, 2010 at http://www.livestrong.com/article/17532-increase-mans-sex-drive/

Melmed S, Kleinberg D. (2008). Anterior pituitary. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. Philadelphia, PA: Saunders Elsevier;

Viewfinder. (2008), Management of a Visual Field Loss. Retrieved on February 18, 2010 at http://www.viewfinderlowvision.com/management.html

Welch. (2009). CSF Rhinorrhea: Treatment. Retrieved on February 18, 2010 at http://emedicine.medscape.com/article/861126-treatment

Wikipedia. (2010). Intracranial Hypertension. Retrieved on February 18, 2010 at http://en.wikipedia.org/wiki/intracranial_hypertension

Wilson, T. (2009).Adrenal Insufficiency: Treatment & Medication. February 18, 2010 at http://emedicine.medscape.com/article/919077-treatment